Do we really have a choice in health care?

As every physician practicing today knows, health care is in a constant state of flux. The latest news from Washington creates even more uncertainty. What we do know is that, for the foreseeable future, there will be an emphasis on team care, coordination, technology and, of course, meeting the requirements of the ever-expanding alphabet soup of acronyms, from MACRA to MIPS and beyond.

As I think about all the changes of the past decade, it’s quite remarkable to see where we are, and how far we’ve come. In the 1990s, most physicians were still in independent or small group practices. Today for the first time, the AMA reports that less than half of all physicians are independent.

And so what? Isn’t that just an inevitable sign of progress? Things change. We adapt or die. The message we hear is: prepare for an era when virtually no MDs are independent and where patients are seen by “advanced practitioners” (aka mid-level providers) via telehealth platforms for all but the most serious illnesses.

Is that the only option — to remove choices for physicians and patients? Let’s hope not. I’d like to live and work in a marketplace where there are options for all physicians and patients. Where we don’t force everyone into the same health care delivery system box. I think such a goal is realistic and attainable because that’s how my partners and I have structured our practice.

With a total of six physicians, we are one of the last of the truly independent medical groups in our area — the central coast of California. Our practice is successful and thriving. Our patients are happy, and my fellow physicians and I love the freedom we have to practice medicine the way we know is best.

No, this isn’t a story about direct pay, which in actuality is starting to flounder. It’s the story of a model that puts the decision of whether or not to participate in a concierge medicine program directly in the hands of patients. My colleagues and I offer a hybrid concierge program, where about 20 percent of our patients opt to participate in the concierge program, the rest we see as traditional insured patients.

One of the features that differentiate our practice from others is that we take insurance, even Medicare. We charge a modest fee, about $150/month to cover service not provided by traditional health insurance. When combined, the services we offer well outpace the fee, making it a real value for patients.

This includes a highly personalized annual exam and consultation visit, direct contact information to us for after-hours questions or emergencies, and convenient scheduling with little to no waiting. Adult children up to 26 are covered under the monthly fee. Plus, our appointment times average about 30 minutes for a follow-up, and an hour for a physical, giving us time to talk with our patients — to look at them — and not the EHR screen in the eye. That’s a welcome change considering that the average physician today reports spending a ridiculous two-thirds of their time on paperwork.

What’s most popular with patients and their families is the patient advocacy and advice. When they are sick and frightened, patients aren’t dropped in the middle of a complex and confusing health care system to fend for themselves. We make the appointments with specialists and labs, get the results promptly and share them in a way that is understandable to patients. We don’t abandon hospitalized patients. We remain actively involved in their care, so we can be ready to take over when they are discharged.

How does that work? Easily: we typically schedule one to two hours per day for our concierge patients. We still have to do what all physicians do: we use EHRs, and we also have to meet requirements for MIPS, etc. My colleagues and I still work hard. The difference is, there is no soul-sucking pressure from working in a grind. We have relaxed and enjoyable time during the day to treat patients the way we think is best. If our concierge schedule isn’t booked, we either see other patients or attend to that always-present paperwork during work hours, not at home when we want to relax with family.

We continue to provide the same care to all patients; that’s a point I can’t stress enough. If someone is in crisis, they are seen first. Our biggest source of growth for the concierge program is keeping all patients happy. If we aren’t meeting their needs, they leave, and we don’t succeed. We aren’t getting rich on this model, but our compensation is fair and our practice stable and growing. Most importantly, we are enjoying the practice of medicine again.

I get that there are questions about any concierge program. I surely had them when I was struggling to find a better way to survive and practice medicine. It came down to some fairly simple questions: what’s best for my patients, community, colleagues and practice? For us, the answer was hybrid concierge. Because patient, as well as insurance relationships, are maintained. The model, pioneered by Concierge Choice Physicians, not only works for small practices like ours, it also works very well for large groups and even vertically integrated health systems.

We know health care will continue to evolve and we’re ready for what comes next. We hope that “next” will include practice models that give real choices to physicians and patients.

Is that important in an era of physician shortages, increasing demand, rising costs? Yes, because the hybrid concierge can bring a private, non-taxpayer source of revenue to health care delivery. One that can stabilize practices, keep physicians practicing longer and ensure all patients are seen. Are there going to be questions and issues that arise? Of course, but let’s address them, not ban options that physicians and patients want. Health care will continue to be complex and at times confounding. As we search for solutions, let’s make sure that choice remains an option that can benefit everyone.

Cary Fitchmun is a family physician.

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